Kaiser Daily Global Health Policy Report

In The News

Associated Press: Officials: Tillerson eyes State Dept budget cut over 3 years
“Secretary of State Rex Tillerson has agreed in principle to a White House proposal to slash foreign aid and diplomatic spending by 37 percent, but wants to spread it out over three years rather than in one dramatic cut. Officials familiar with Tillerson’s response to the proposal from the Office of Management and Budget said Friday that Tillerson suggested the reductions to the State Department and U.S. Agency for International Development begin with a 20 percent cut in the next budget year…” (Lee, 3/3).

Los Angeles Times: Here’s one way of fighting terrorism that the U.S. may be rethinking under Trump
“…[A] strategy that the U.S. and other wealthy countries have turned to increasingly in recent years: using development aid as a means to prevent terrorism and violent extremism. The future of that approach is now in question under the Trump administration, which has proposed sharp cuts in foreign aid programs generally…” (Sewell, 3/5).

Reuters: Trump administration to propose ‘dramatic reductions’ in foreign aid
“… ‘We are going to propose to reduce foreign aid and we are going to propose to spend that money here,’ White House Office of Management Budget director Mick Mulvaney told Fox News on Saturday, adding the proposed cuts would include ‘fairly dramatic reductions in foreign aid.’ Mulvaney said the cuts in foreign aid would help the administration fund a proposed $54 billion expansion of the U.S. military budget. ‘The overriding message is fairly straightforward: less money spent overseas means more money spent here,’ said Mulvaney, a former South Carolina Representative…” (Shepardson, 3/4).

Devex: Trump issues first guidelines on ‘global gag rule’ implementation
“The administration of U.S. President Donald Trump has issued the first official guidance for implementation of the Mexico City policy, also known as the ‘global gag rule.’ The roll-out of the standard provisions, issued Friday … effectively make the global gag rule operational for family planning awards under USAID, according to the reproductive health care group PAI. … Trump’s version [of the policy] also targeted all global health assistance. However, the standards issued on Friday so far only touch on family planning, and they are actually identical to the guidance issued in 2001 by President George W. Bush, as PAI noted…” (Lieberman, 3/3).

Vox: Trump has set the U.S. up to botch a global health crisis
“…[T]he chances of the U.S. being hit with some kind of pandemic in the next four years is high. (The U.S. is already fighting Zika within its borders …) Based on what we’ve seen from President Donald Trump so far, the U.S. seems poised to botch an outbreak response. ‘America has long been unprepared for a dangerous pandemic,’ Ron Klain, the former Ebola czar under President Obama, told Vox, ‘but the risks are especially high under President Trump.’ Let’s walk through the four reasons why. 1) Trump hasn’t named a CDC director and could cut 12 percent of its budget … 2) ‘America first’ doesn’t work during pandemics … 3) Trump has advocated for closing borders to countries dealing with outbreaks. That’s dangerous. … 4) The fallout from Trump’s travel ban could hamper research collaboration that could save lives…” (Belluz, 3/4).

Devex: Q&A: UNFPA’s Babatunde Osotimehin on family planning in the face of uncertainty
“…Among those speaking [last week at the She Decides conference] was Dr. Babatunde Osotimehin, executive director of the U.N. Population Fund and former minister of health of Nigeria. He told Devex that the conference and fund was not about abortion: ‘This is (about) sexual and reproductive health and rights — the whole range of services — and empowering women to take charge of their lives; that is what it was about,’ he said. With the future of U.S. contributions to UNFPA also unclear, Dr. Osotimehin spoke to Devex about the role of family planning in achieving the Sustainable Development Goals and how to shore up programs in uncertain times…” (Abrahams, 3/6).

CNN: Polluted environments kill 1.7 million children each year, WHO says
“Each year, environmental pollutants cost an estimated 1.7 million lives among children under five, according to World Health Organization reports released Monday…” (Senthilingam, 3/5).

Reuters: Polluted environments kill 1.7 million children a year: WHO
“A quarter of all global deaths of children under five are due to unhealthy or polluted environments including dirty water and air, second-hand smoke, and a lack or adequate hygiene, the World Health Organization (WHO) said on Monday…” (Kelland, 3/5).

“Secretary of State Rex Tillerson is pushing back against the White House’s proposal to drastically slash funding for diplomacy and development, a sign he intends to fight for his department’s mission inside the Trump administration. Tillerson’s formal appeal of the [Office of Management and Budget’s (OMB)] initial budget proposal seeks to restore some of the huge cuts proposed by the White House for State Department and foreign assistance funding, according to an internal State Department memo I obtained. … Multiple State Department officials told me that Tillerson and his senior staff have been talking with heads of various bureaus and offices at the State Department to get a better idea of their top priorities, as part of his effort to shape his position on the budget cuts. ‘Our appeal is focused on increasing the overall topline and will seek to restore cuts made to our core economic and development accounts, security assistance, and humanitarian aid,’ the memo states. ‘We are also asking OMB for more time and flexibility to enable us to determine most bureau and country level allocations at a later date.’ … The bottom line is that funding for diplomacy and development will be the subject of a series of negotiations and will likely fall somewhere between what the White House and Congress each want. Tillerson’s challenge is to navigate between those two power centers and do as much as he can to defend the programs he believes in” (3/3).

The Guardian: Women are suffering globally — we must act now
Members of the Scientific and Technical Advisory Group and the Gender and Rights Advisory Panel of the Human Reproduction Programme

“…Current global trends — increasing stigmatization of essential information and health services, continued support for harmful practices such as child marriage and [female genital mutilation (FGM)], increasing restrictions on contraceptive services and abortion care, and decreasing funding — threaten the provision of life-saving care needed by women and girls, especially the poorest and most marginalized. We fear that the significant gains made over the past three decades … will be compromised. As an independent, global body of scientists, we call on the international community, governments, private sector, and others to protect everyone’s right to the highest attainable standards of sexual and reproductive health, to safeguard the tremendous progress made to date, and to take all necessary steps to sustain and expand sexual and reproductive health programs and research. This situation harms women and threatens the capacity of all states to honor and fulfill their pledge [to the Sustainable Development Goals]…” (3/2).

Financial Times: Letter to the editor: A baffling omission from the ‘priority pathogen’ list
Lucica Ditiu, executive director of the Stop TB Partnership; Mel Spigelman, president and CEO of the TB Alliance and co-chair of the Working Group on New Drugs at the Stop TB Partnership; and José Luis Castro, executive director of the International Union Against Tuberculosis and Lung Disease

“Sir, The World Health Organization has badly misstepped in leaving out Mycobacterium tuberculosis (M.tb) from its list of 12 priority superbugs for which new antibiotics are needed urgently. … Although TB is a bacterial disease, currently available antibiotic medicines simply cannot keep up against rapidly evolving resistance. … TB patients desperately need new and better medicines, and drug-resistant TB needs to be acknowledged as the biggest health threat in the antibiotic resistance crisis. … Yet the TB research community remains badly underfunded. … In light of this, the World Health Organization’s decision to omit M.tb from this ‘priority pathogen’ list is baffling. We have the evidence that no action in the fight against global antibiotic resistance can be truly effective if it does not include tackling tuberculosis. Therefore, we urge WHO to revise the list and include Mycobacterium tuberculosis” (3/5).

“…[T]he superbug problem has been well understood and managed since the George W. Bush administration. CDC surveillance, physician education, and infection-control protocols have led to more prudent use of antibiotics. … Still, a study in the Journal of the American Medical Association last year estimated that almost a third of U.S. antibiotic prescriptions are unnecessary … The larger danger is that no new class of antibiotics has been introduced since 1984 and [Food and Drug Administration (FDA)] approvals since have been merely variants of old medicines. Antibiotics R&D is challenging and expensive because only a small number of patients who acquire these infections meet the conditions for traditional clinical trials. The profit motive is weak because any new antibiotic would need to be closely reserved for only the most serious new infections. Congress tried to change these incentives with the 2016 Cures Act, which increased funding for basic research and created a new antibiotic-specific FDA pathway with streamlined trials. Let’s hope these reforms — and the FDA — will allow researchers to find new antibiotics ahead of a potential 21st-century plague” (3/5).

Global Health NOW: A Single Bracelet Does Not Jingle
Ousmane Faye, project director of the USAID-supported Integrated Health Project

“…In the Democratic Republic of the Congo (DRC), a country beleaguered by years of civil war, official corruption and mismanagement, and civil apathy, the path to building a strong health system is challenging. One initiative, focused on building up community-level care, has shown success — but without more support from the Congolese government, it might not continue. The USAID-funded Integrated Health Project (IHP) aims to increase the availability of health services for the most vulnerable people in the country … Of all the IHP interventions, … we have found that the single most cost-effective and effective is a volunteer community health worker initiative called ‘integrated community case management.’ But after its initial five-year run, IHP is coming to a close. And if the Congolese government doesn’t make its own investments to leverage the important efforts already under way, the lives of countless children will be at risk. … Until that commitment is made, the health of some of DRC’s most vulnerable people will continue to rely on international donors. If everyone involved in building the country’s health system doesn’t get serious about these promising community efforts, moms and kids will perish first and, as a result, the rest of the country will suffer” (3/3).

From the Global Health Policy Community

Center for Global Development’s “Global Health Policy Blog”: What Happens without U.S. in Global Health?
Amanda Glassman, chief operating officer and senior fellow at CGD, asks, “[W]hat would happen if the rumored steep cuts to foreign aid are applied to USG global health spending…? Though the U.S. contribution to global health is small in absolute terms, it has an outsize influence on peoples’ lives. … If cuts must happen, time must be allowed to construct a response that will minimize harm and suffering. Hopefully, Congress holds the line on applying across-the-board cuts and instead takes a moment to reassess where we are in the global health response, and how we can deploy our very limited funding to improve health and assure alignment with U.S. interests” (3/3).

Center for Global Development’s “Global Health Policy Blog”: She Decides, But Who Pays?
Rachel Silverman, senior policy analyst at CGD, discusses the need for and challenges of global funding for women’s reproductive and sexual health and rights programs, including the potential implications of U.S. policy changes on global reproductive health and pledges made at the ‘She Decides’ conference. Silverman writes, “[T]the current situation clearly illustrates the dangers of donor dependency when women’s lives hang in the balance, and especially when one country accounts for such a big portion of total support. Donors can help mitigate the risk from the current situation, and possible policy changes in the future, by helping incentivize countries to fund these services from their own domestic budgets. … [T]hree cheers to the pledging countries, and to the She Decides leaders for their quick and bold mobilization. But let’s temper our celebration with some realism — there’s much more still to do” (3/3).

Center for Strategic & International Studies’ “Take as Directed”: Tom Malinowski on Ethiopia and the U.S. role in human rights
Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Tom Malinowski, former assistant secretary of state for democracy, human rights, and labor, who “discusses the complicated human rights dialogue between the U.S. and Ethiopia, and reflects on his tenure at the State Department. He also provides his thoughts on human rights under the Trump administration” (2/24).

Center for Strategic & International Studies’ “Take as Directed”: RADM Tim Ziemer Looks Back at 10+ Years Leading PMI
J. Stephen Morrison, senior vice president at CSIS and director of the CSIS Global Health Policy Center, speaks with Rear Admiral Tim Ziemer, who led the President’s Malaria Initiative (PMI) for 10 years (2/10).

Center for Strategic & International Studies’ “Take as Directed”: Amb Deborah Birx reflects on PEFPAR’s achievements and priorities
Sara M. Allinder, deputy director and senior fellow at the CSIS Global Health Policy Center, speaks with Ambassador-at-Large Deborah Birx, coordinator of U.S. government activities to combat HIV/AIDS and U.S. special representative for global health diplomacy, “about PEPFAR’s accomplishments [and] what is next in terms of PEPFAR priorities” (2/10).

Center for Strategic & International Studies: Promoting Accountability in Nigeria’s Health System
In this report, Richard Downie, deputy director and fellow in the Africa Program at CSIS, examines Nigeria’s health system and offers recommendations on how the U.S. administration may engage effectively with Nigeria on health (2/23).

Global Fund to Fight AIDS, Tuberculosis and Malaria: Global Fund Names Marijke Wijnroks Interim Executive Director
“The Board of the Global Fund has appointed Marijke Wijnroks as Interim Executive Director, to serve from 1 June 2017 until a new executive director selected by the Board is able to begin. Dr. Wijnroks has served as a leader at the Global Fund since 2013, effectively acting as second in command to Mark Dybul, the current executive director, who steps down on 31 May 2017 after completion of a four-year term. … The Board decided on 27 February to continue its search for a new executive director. The Board will launch a new search process, with the aim of selecting the next executive director later this year…” (3/3).

From the U.S. Government

President’s Malaria Initiative: U.S. President’s Malaria Initiative’s Strategic Effort to Reduce the Threat of Emergence and Spread of Multidrug-Resistant Malaria
Highlighting a case study on drug-resistant malaria recently published in the New England Journal of Medicine, this blog post discusses PMI’s work to reduce the threat of multidrug-resistant malaria in Africa and the Greater Mekong sub-region (3/1).

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The Kaiser Daily Global Health Policy Report is a free daily publication that provides the latest news and information on global health policy, with a focus on U.S. global health policy and the developments that have important implications for the U.S. global health response.